BUKU INDUK LEMBAGA PENDIDIKAN AL-QUR’AN (LPQ)

TAMBIHUL GHOFILIN
Duriwetan Kecamatan Maduran Kabupaten Lamongan Jawa
Timur

NOMOR INDUK : ..................

Foto Santri

A. SANTRI
1. Nama : ...............................................................................................
2. Jenis Kelamin : ...............................................................................................
3. Tempat dan Tanggal Lahir : ...............................................................................................
4. Anak : Ke …………. dari……………..bersaudara
5. Alamat : ...............................................................................................

B. ORANG TUA / WALI

1. Nama Orang Tua
a. Ayah : ...............................................................................................
b. Ibu : ...............................................................................................
2. Pekerjaan Orang Tua :
a. Ayah : ...............................................................................................
b. Ibu : ...............................................................................................
3. Alamat : ...............................................................................................
4. Nomor Telepon : ...............................................................................................

C. MASUK LPQ
1. Pada Tanggal : ...............................................................................................
2. Kelas/Iqra : ...............................................................................................

IV.MENINGGALKAN LPQ
1. Pada Tanggal : ...............................................................................................
2. Kelas /Iqra : ...............................................................................................
3. Alasan : ...............................................................................................
 BUKU INDUK LEMBAGA PENDIDIKAN AL-QUR’AN (LPQ)
TAMBIHUL GHOFILIN
Duriwetan Kecamatan Maduran Kabupaten Lamongan Jawa
Timur

NOMOR INDUK : ..................

Foto Santri

A. SANTRI
1. Nama : ...............................................................................................
2. Jenis Kelamin : ...............................................................................................
3. Tempat dan Tanggal Lahir : ...............................................................................................
4. Anak : Ke …………. dari……………..bersaudara
5. Alamat : ...............................................................................................

B. ORANG TUA / WALI

1. Nama Orang Tua
c. Ayah : ...............................................................................................
d. Ibu : ...............................................................................................
2. Pekerjaan Orang Tua :
c. Ayah : ...............................................................................................
d. Ibu : ...............................................................................................
3. Alamat : ...............................................................................................
4. Nomor Telepon : ...............................................................................................

C. MASUK LPQ
1. Pada Tanggal : ...............................................................................................
2. Kelas/Iqra : ...............................................................................................

IV.MENINGGALKAN LPQ
1. Pada Tanggal : ...............................................................................................
2. Kelas /Iqra : ...............................................................................................
3. Alasan : ...............................................................................................